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The study of disaster triage is made difficult by the complex emotional response of potentially lifesaving intervention that a triage officer must make decisions based on a succinct and efficient algorithm.
Methods
We designed a survey of triage professionals in Chicago, Philadelphia, and Beijing to identify sources of emotional bias that lead to failure of the START triage protocol that result in a lack of correlation between triage priority and clinical outcomes.
Results and Conclusions
Among our subjects, we observed that a pediatric victim is uniformly overtriaged when compared to less injured victims. We examine the possible reasons behind the consistency of this selection, explain the means we used to minimise bias, and propose avenues for further research and clinical implementation of better triage systems and guidelines.
The Disaster Medicine Centre “Zaschita” is a coordinating center with the general goal of management and medical relief delivery in response to major emergencies. The Russian Disaster Medicine Service has accumulated a national and international experiences of emergency responses to earthquakes (Columbia 1999, Neftegorsk 1995, Turkey 1999, Iran 2003, Afghanistan 2002, China 2008, etc.). The Health Ministries of the Russian Federation and of Peoples Republic of China have concluded a treaty of collaborative activities in the field of in public health services and disaster medicine. The promotion of cooperation in health sector is based on the key elements of collaboration, which is an a method coping with emergencies. All activities have been discussed during annual meetings, and are planned for participants on the basis of practical field experience and of emergency medical care technologies. These include: (1) mechanisms of trans-boundary field collaboration in management during major disasters; (2) sharing of field experiences for coping with natural disasters; (3) early warning networks and information technologies; (4) staff preparedness programs and postgraduate education; (5) new psycho-physiological technologies for staff selection, training, and conformity of medical teams; (6) coordination and management of international-scale exercises; (7) technology of medical relief provided for injured in major disasters; and (8) lessons learned from technological emergencies. The details of the consequences and issues associated with mutual management will be discussed.
Disaster medicine is a young discipline and there is a need for the development of methods for evaluation and research. This includes full-scale disaster exercises that are quite costly. Within each organization these exercises are seldom conducted. If there was a standardized concept on how to conduct as well as evaluate these exercises, this could lead to better knowledge and cost effectiveness. The aim of this study was to increase awareness of the possibility to develop and conduct full-scale exercises in different settings using performance indicators combined with indicators related to patient outcome serving as a basis for comparison and evaluation process.
Methods
Two full-scale exercises in different organizations were studied. Identical panorama with the same number and type of casualties was used. Sets of performance indicators combined with indicators for unfavorable patient outcome, according to the Emergo Train System®, were recorded as well as all transportation times and the patient distribution to selected hospitals. Qualified observers scored the results on predetermined locations; on the scene, hospital and strategic command and control.
Results
The lowest scored performance indicators were “first report to dispatch”, “second report from scene” and “first patient evacuated”. Due to insufficient response and evacuation times of victims to the receiving hospitals the unfavourable patient outcome, regarding preventable deaths and preventable complications were 28% (n = 18) and 41% (n = 17), respectively.
Conclusions
Standardized full-scale exercises where the same type of results is recorded can be conducted. This combination of performance indicators and Emergo Train System® leads to probabilities of development and better command and control response. Future use of the same concept may demonstrate important results that will lead to new and better knowledge that can be applied during real incidents.
During the summer months in Australia, school leavers celebrate their end of school life at Schoolies festivals around the nation. These events are typically described as a mass gathering as they are an organised event taking place within a defined space, which is attended by a large number of people.
Discussion and Observations
Two research projects were undertaken to understand the Schoolies phenomenon. The first project was to understand the event as a mass gathering. The second to determine what was important to stay safe and healthy at this event from a young person's perspective. To understand the Schoolies event as a mass gathering Arbons conceptual framework was used which considers the psychosocial, environmental and biomedical aspects of the event. This study found that the crowd mood of the Schoolies were expressive, social and participatory. The environment was bounded, ticketed and dry. The bio-medical data showed a high patient presentation rate when compared to the Australian average. However most of the presentations were minor. What was of concern to the researchers were the high level of risky drinking that took part a this event. The second study used postcards to understand what young people perceived to be important to their health and safety whilst at Schoolies. 3 lead questions were used, and 9 items placed underneath each question to be ranked by participants. Data collected showed that exposure to illicit drugs and violent behaviour where of concern to them. The results from these studies highlights the need to re focus the Schoolies event to be inclusive of strategies that not only support young people to party safely, such as dry zones, but to support young people to feel safe from exposure to drugs, and to violence (physical and sexual) that can occur for many reasons.
Major earthquakes with a magnitude of 7-8 are anticipated to occur in the next 30 years at a 60 percent chance on the southern coast of Mie, Japan. Since the most part of the Mie Prefecture, Japan, is likely to be damaged by tsunami and landslides, residents are expected to take self-reliant approach on the initial several days after the earthquake.
Aim
Developing disaster support system in including community based medical disaster preparedness in the region.
Methods
We have been providing knowledge and techniques to cope with the earthquake cooperated with experts of earthquake engineering. Basic and advanced life support educational programs for acute illness and trauma that may occur in earthquake and/or tsunami as well as during the evacuation and sheltering have been developed for public, local medical associations and the main hospital in the region. Moreover, we have started a new community continuous educational course to promote the public disaster preparedness. We teach introduction of emergency and disaster medicine to enhance knowledge of natural and social science on disaster preparedness.
Results
Local residents including public and medical personnel started to acquire a general idea of disaster and emergency medicine. The educational programs seemed to motivate local residents and healthcare professions.
To describe the demographics, mechanism, pattern, and severity of injury, prehospital and hospital care (first 24 hours) and the patient outcome in severely injured children in a NICU. This study was made to complete the study of Swedish children admitted to a paediatric intensive care unit (PICU) due to major trauma in the same region and during the same period.
Method
The medical records of 124 traumatized children (0–16 years of age), admitted to the NICU in Gothenburg 1992–2001, were retrospectively examined. The Injury Severity Score (ISS), Glasgow Paediatric Coma Scale (GSC), Revised Trauma Score (T-RTS/RTS), Paediatric Trauma Score (PTS), Trauma Score Injury Severity Score (TRISS) and Paediatric Risk of Mortality Score (PRISM) estimated the severity of injury.
Results
About 7/100 000 children with severe injuries were admitted to the NICU each year from 1992–2001 inclusive. Epidemiology showed a similar pattern as in other OECD countries. Severity of injury was recorded as an ISS median of 17. Mortality rate in our series was 6%.
Conclusion
Major trauma with admission to a NICU is rare in Swedish children. With management in conjunction with a pediatric centre, these children have a good survival rate.
Prehospital delay in trauma victims has been associated with worsened trauma outcomes, and forms the basis of emergency medical services (EMS). Survival rates of severely injured patients with life and limb threatening trauma were studied and corrlated with prehospital delays in Mumbai, India, where there is no central EMS system.
Methods
From October 2010 to March 2011, a researcher collected Injury Severity Score and prehospital time delay data in all severely injured patients arriving at the Trauma Centre. The time of injury, and time and mode of transport to the Trauma Centre were recorded, along with the details of the injury and the physiological parameters upon admission. Information regarding time and place of the crash, arrival to a trauma care facility, injuries, and survival were noted.
Results
A taxicab was the most common mode of transport followed by a police van, private ambulances, and government ambulances. Patients reached the Trauma Centre more quickly when accompanied by relatives or police, and took longer if they were examined at peripheral centers, were unknown victims, or arrived by Government ambulances. Better outcomes were observed in patients with informal carers. The majority of the victims presented within three hours of trauma.
Conclusions
Prehospital delay did not correlate well with poorer outcomes. Further research is needed to determine how many injured die on the way to the hospital in countries without a formal EMS system. Implementation of a high-cost, state-funded EMS system in a congested, resource-poor, urban setting must be balanced with the insufficient evidence about whether prehospital field interventions actually improve survival outcomes.
There are 60 Poison Centers in the United States that manage over 2.5 million poison exposure calls each year. A poison center can be reached 24 hours a day by dialing a national 800 hotline. Poison Centers are staffed by Specialists in Poison Information who are highly trained in clinical toxicology and are very skilled in telephone triage.
Discussion
ATSDR and the Poison Centers in HHS/FEMA Region 6 developed draft guidance for incorporating Poison Centers into the National Response Plan. That framework was used to incorporate Poison Centers into the gulf oil spill response of 2010. The National Poison hotline was promoted to provide medical support for those with health effects or health questions related to the spill. During the response the surveillance capabilities of the National Poison Data System (NPDS) were highlighted. The Louisiana Poison Center (LPC) and the other gulf states Poison Centers provided information on health effects related to the spill. Information was provided by the LPC to the Louisiana Department of Health and Hospitals, Office of Public Health Section of Epidemiology and Environmental Toxicology, public information officer to assist in briefing the Governor, the Louisiana Governors Office of Homeland Security and Emergency Preparedness to post to the Virtual Louisiana website, as well as ATSDR, CDC, EPA, and other agencies participating in the gulf response unified command. Poison Centers, for the first time, participated in a response on a national level, providing medical support for those with symptoms or medical questions related to the spill. In addition to assisting in the medical care of those exposed to substances related to the oil spill and the response efforts, Poison Centers also responded to questions about air and water quality and seafood safety.
Conclusion
Poison Centers are a valuable resource to assist in emergency response plans.
Out-of-hospital cardiopulmonary arrest (OHA) is an international health issue. There is an urgent need to better understand the key factors that affect OHA survival. Epidemiological surveillance is the first step towards scientific understanding of the problem. This study looks at the profiles of patients who suffered an OHA.
Methodology
In this retrospective study, the medical records of all patients who died upon arrival at Tan Tock Seng Hospital, Emergency Department (TTSH ED) between 1st January 2009 and 31st December 2009 were reviewed. The outcomes include patient demographics, pre-hospital management and the cause of death.
Results
Within the study period, there were a total of 275 OHA, 5 (1.8%) traumatic and 270 (98.2%) non-traumatic cases. Emergency Medical Service (EMS) conveyed 247 (91.5%) of OHA and 23 (8.5%) arrived by self-transport. The incidence of non-traumatic OHA was 14 per 10,000 ED attendees, predominantly male (72.2%). Male were significantly younger than female (63 vs 70 years, p = 0.002). The commonest initial cardiac arrhythmia recorded on scene by paramedics was asystole (54.1%), pulseless electrical activity (34.8%) and ventricular fibrillation (11.1%). One hundred sixty-one (59.6%) patients collapsed during the day (0600 – 1759 hours). Patients found in ventricular fibrillation on scene peaked in the morning (1020hours). All OHA were started on cardiopulmonary resuscitation, intubated with laryngeal airway mask, given intravenous adrenaline, and all ventricular fibrillation was electrically defibrillated en-route by the paramedics. Despite continued resuscitative efforts in the ED, all remained in asystole. The State Coroner reviewed 266 (96.7%) OHAs, of which, 96 (36%) were subjected to post mortem. Among patients with asystole at scene, acute coronary syndrome (55.2%), hypertensive heart disease (13%) and bronchopneumonia (5.2%) were the three commonest cause of death. The commonest cause of death for ventricular fibrillation at scene was acute coronary syndrome (76.7%), of which 10 (43.5%) had no pre-existing medical conditions.
Conclusion
In our study population, majority of patients had asystole as their presenting arrhythmia at scene. OHA with ventricular fibrillation demonstrated significant circadian differences and the underlying cause of death was acute coronary syndrome. This knowledge will allow EMS to devise future strategies that have the greatest potential to improve survival outcomes.
The emergency department (ED) deals with serious diseases, trauma, and terminal stage cases. The mortality pattern of cases in the ED must be assessed for future planning and development.
Objectives
The aim of this study is to evaluate the pattern of the mortality cases in ED.
Methods
Retrospective mortality data were collected and analyzed during April to September 2010 from the Tribhuvan University Teaching Hospital.
Results
There were 81 mortality records found during the study period. The mortality rate among the ED cases was 36 per 10,000 (0.36%). Sixteen (19.75%) were dead upon arrival to the ED. Among the remaining 65 mortality cases, 30 (46.2%) were male and 35 (53.8%) female. The ages ranged from 1 to 80 years; the mean age for males was 43.8 years and 55.0 years for females. The mean time duration from when the patient was bought to the ED to death was 6.7 hours. The primary causes of mortality were hypovolumic with hemorrhagic shock (10, 15.5%), aspiration pneumonitis (9, 13.8%), cardiopulmonary arrest (8, 12.4%), sepsis and septic shock (7, 10.8%), severe head injury (6, 9.3%), acute exacerbations of chronic obstructive pulmonary disease (6, 9.3%), hemorrhagic cerebrovascular accident (3, 4.7%), hepatic encephalopathy (3, 4.7%), cardiogenic shock (2, 3%), chronic renal failure (2, 3%), dyselectrolytemia (2, 3%), anaphylaxis (1, 1.5%), acute respiratory distress syndrome (1, 1.5%), meningoencepahalitis (1, 1.5%), acute myocardial infarction (1, 1.5%), OP poisoning (1, 1.5%), pulmonary edema (1, 1.5%), and severe pneumonia (1, 1.5%).
Conclusions
The mortality in the ED is due to the high rate of severe and serious cases that arrive at late stages of disease. It also is accounted with severe trauma cases despite vigorous treatment at the ED. The rate also is increased by “Brought Dead” cases which could be reduced with proper emergency medical services.
The ultimate goal of medical disaster management must be to predictably orchestrate transition from “standard of care” to “sufficiency of care” using evidence-based methods. However, neither descriptive reports of disaster responses nor epidemiological studies investigating disaster risk factors have been able to provide validated outcome measures as to what constitutes a “good” disaster response. Moreover, it either has been considered impossible, ethically inappropriate, or both, to identify experimental and control groups essential for hypothesis testing for the conduct of scientific randomized controlled clinical trials.
Objective
The aim of this study was to identify a number of performance and outcome indicators and define optimal disaster response and management decision-making for various disaster scenarios using simulation optimization.
Methods and Results
A system model of medical disaster management was designed, and victim models and performance and outcome indicators were developed. Various mass-casualty and large-scale disaster scenarios were developed, including: (1) a hospital emergency incident/disaster; (2) a CBRNE incident; (3) an airplane crash and airport disaster; (4) a mass gathering; and (5) a military battlefield mass casualty. Using “Discrete Event Driven Simulation”, multiple replications were made for different decision-making modalities, different resource allocations, and different disaster response procedures. Statistical analysis and optimization techniques were applied to achieve the best available setting of parameters of the simulation model. In such a way, the “Medical Disaster Management Simulator” runs the “missing experimental studies” in a simplified artificial simulated disaster environment.
Conclusions
Simulation optimization is an adequate tool for judging and evaluating the effectiveness and adequacy of health and relief services provided during disaster medical response. Evidence-based recommendations and codes of best practice were formulated for optimal medical disaster and military battlefield management in different large-scale event scenarios as well as for teaching, training, and research in medical disaster management.
What is the difference between a “disaster” and an “emergency”? One can safely say that for the victim of an event, it is always a disaster. But what about the first responders who are tasked with returning conditions to normal as quickly as possible? What about the executives who must direct the first responders, as well as coordinate resources? The difference is a “matter of degree” because it depends on the amount of resources that are required to respond to the incident. For example, an overturned gasoline tanker truck may only be an emergency for a major metropolitan area, but a disaster in a more rural region. American public safety is a mirror image of the government system of federalism that developed during the founding of the United States. Public safety entities are attached to the various local, state, and federal government agencies. There are almost 18,000 local law enforcement agencies across the US. Only 47 agencies have more than 1,000 sworn officers, while almost 90 percent have less than 50. There are more than 30,000 fire departments, yet only about one-quarter of all firefighters are full-time professionals. The rest are volunteers. The author, a 30-year law enforcement veteran, has developed a college-level course for public safety executives to help them understand the “matter of degree.” The intent of the course is to challenge executives to conduct a careful self-examination of their own public safety agencies to determine what they are capable of doing in an event. An executive only gets one chance to do it right, so being able to distinguish between a disaster and an emergency response will be critical to success. When the event occurs, a public safety executive will be better prepared to make key decisions.
On 11 June 2009, an Influenza A (H1N1) pandemic was declared by the World Health Organization (WHO). The Major Medical Incident Regional Command and Control Protocol in the County Council of Östergötland, Sweden was activated. After vaccinations were competed, it was decided that the operation should be evaluated in a retrospective study. This study aims to increase knowledge regarding regional management of a pandemic flu.
Methods
All protocols from regional command meetings were studied together with central data regarding, logistics, vaccination site reports, incident reports, and all written correspondence between involved departments. Information from results of a questionnaire that was distributed to all vaccination site managers were summarized and studied. In addition, an interview was performed with the chief of medical operations.
Results
Out of the approximately 426,000 inhabitants of the county, a total of 224,780 (53%) were vaccinated during a five and a half month period. The mean pace was 1,246 vaccinated per day (range 0–9643). Regional command had 41 recorded meetings resulting in a collected number of about 740 working hours. Three hundred sixty-six employees were involved in the vaccination, working 38,741 hours. Twenty-eight safety and 52 security incidents were reported. Uncertainty about vaccine delivery and keeping the public's interest were reported to be of concern for the management.
Discussion
Even with the large scale of the operation, there were only a few security and safety issues. Although the goal of vaccinating 75–80% of the inhabitants was not reached, it could be assumed that the pandemic was dampened. Given the public's high initial interest, it could be considered that vaccination should not start until a large number of doses have been delivered.
Conclusion
The medical incident command structure and protocol successfully can be adapted to a mass vaccination event. Information from the Östergötland County Council operation yielded significant experience for future mass vaccinations.
To investigate the association of cardiac Risk factors and the risk of Acute myocardial infarction, in ED patients with non-diagnostic ECG. Methods:
Results
474 patients were enrolled,150 had non diagnostic ECG In this study HTN with p-value = 0/012 (> 0/05), HIP with p-value = 0/0001 (> 0/001), FH with p-value = 0/001(> 0/01) was significantly more prevalent in those who ruled in for AMI.
Conclusion
In the past studies in patients with non-diagnostic ECG only hypertension Was significantly more prevalent in those who ruled in for AMI and cardiac risk factors have limited clinical value in diagnosing of AMI in ED patients. In this study HLP, HTN, FH was significantly more prevalent in those who ruled in for AMI An observational study is conducted in an educational hospital in Shahid Beheshti university during a period of two years. In this study, patients with symptoms suggestive of AMI including. chest pain, Dyspnea, palpitation, syncope, cerebrovascular accident, nausea, vomiting, vertigo, loss of consciousness were enrolled. Demographic, historical feature and risk factors, such as age, sex, diabetes, hypertension, hyper lipidemia, renal failure, positive family history of CAD, smoking, substance abuse, Alcohol use in the past 24 hours, cocaine use in the past 48 h were recorded. Nondiagnost ECG including these categories: Normal, non specific, early Repolarization, abnormal without signs of ischemia such as old bundle branch block, LVH, … A final diagnosis of Acute myocardial infarction was determined by CK - MB and Troponin - 1.
The prerequisite of improving the situation of traffic accidents and injury prevention is to set up a “Road Traffic Accident and Victim Information System (RTAVIS)” which does not exist in Iran. The objective of this study was to compare the three major sources information including police, emergency medical service and hospitals to show the necessity of integrated road traffic injury surveillance system.
Method
This prospective cohort study has been done by pursuing each road traffic accident (RTA) case within 30 days of its occurrence by a draft questionnaire and data pooling from participating sources during one year.
Results
In this study, after aggregating/ pooling the data from all organizations, it was finally revealed that during one year 254 injury crashes happened in Tehran–Abali road (with 45 Kilometer distance) in which 434 people were injured or died. Out of these injury crashes, Police and Emergency Medical Services (EMS) stated to be unaware of 67 and 51 cases, respectively. In other words, Police, pre- hospital emergency service and hospital have reported 56.2% 82.9% and 76.4% of the entire number of injuries or deaths respectively.
Conclusion
None of the information sources including police, EMS and health care facilities has complete information about injuries and deaths caused by traffic accidents. It seems that formulating and implementing a centralized and multidisciplinary data collection system of national traffic accidents with the collaboration of police, Ministry of health and medical education (EMS and medical centers), forensic medicine, and Iranian Red Crescent is necessary.
The state of Western Australia has a remote population spread throughout an immense area. Remote health and retrieval is strained on a day-to-day basis, let alone in mass casualty incidents (MCIs). Anecdotally, remote medical staff has minimal training in MCI response. There is no research into how aware these staff is on principles of MCI response.
Methodology
An online survey was devised to ascertain the awareness and knowledge of medical staff most likely to be involved in a disaster. Demographic as well as questions in scenario format were disseminated to rural general practitioners (GPs), nurses and paramedics. Data was collected over a 4-month period.
Results
117 surveys were completed online. Analysis revealed an astute awareness of resources and environment in a potential MCI but triaging was poor and complex decision-making results were equivocal. Trained respondents handled scenarios better than experienced (MCI involvement or planning) respondents.
Conclusions
In general, remote medical staff is aware of only certain MCI principles. Further training is warranted. Voluntary feedback from these staff also strongly corroborated this view.
Unintentional household injuries are a major public health problem that affects large numbers of people. Various population-based surveys from the literature showed > 40% of households reporting an injury that required medical attention. However, there is a general lack in comprehensive population surveys to highlight the risk of post-injury, help-seeking behavior and its associated financial cost. This study is part of the urban, home-based injury epidemiological study series (2007–2010) in Hong Kong.
Methods
A population-based, cross-sectional, random telephone survey was conducted using the last birthday method in 2009. A study instrument was developed and validated based on the modified Chinese World Health Organization guidelines for injury and violence surveys.
Results
The study population comprised of non-institutionalized, Cantonese-speaking Hong Kong residents (n = 6,570). Among the 39.4% self-reported injuries within the past 12 months, only 8.6% of injured people had sought medical care. Respondents tended to seek medical care from the private setting in the first episode of post-injury treatment. Among health seekers, 70% of the injured participants reported having to seek a second treatment and the care-seeking pattern shifted from private to public medical service delivery setting. Predictors of service preferences were identified and discussed.
Conclusions
Medical care seeking patterns post-unintentional household injury was identified. Medical and emergency services providers may wish to consider health service implications.
Recordings of heatwaves date back to the early 1900s and usually are associated with high mortality. In Australia, heatwaves have been the major cause of natural hazard-related deaths. Heatwaves usually do not carry the global media coverage associated with other disasters, and frequently, are referred to as silent disasters. The main impact of heatwaves is on health and human life.
Objectives
Preliminary results are presented for the 2009 heatwave, investigating the emergency department patient presentations from three public hospitals in Adelaide, a city in the central southern area of Australia.
Methods
Demographic and syndromic data were obtained from emergency department records. Ethics permission was obtained prior to data collection. Heatwave conditions occurred from 26 January–07 February 2009. Two non-heatwave periods were day-matched approximately two weeks before and after the heatwave. Data were analyzed by age groups, gender, and ICD codes for chronic conditions.
Results
The two largest groups of people presenting were between 15 and 64 years of age and > 75 years of age during the heatwave and non-heatwave periods. During the heatwave period, both groups had significant increases in patient presentation related to renal problems (ICD 10: N000-N3999) and dehydration and hyperthermia (ICD10: E86, T67). The latter syndrome was far more accentuated during the heatwave, with emergency department patient presentations rising from 2 (non heatwave) to 62 presentations for the 15 and 64 years cohort and from 4 (non heatwave) to 91 for the > 75 years cohort. Cardiovascular- and respiratory-related presentations showed slight increases during the heatwave, while mental health had high presentations for the 15–64 year cohort throughout heatwave and non heatwave periods.
Conclusions
Both young and older people were affected by heatwave, and precautionary warning should be used throughout the community to alert people of the dangers underlying extreme heat conditions.
Response time performance for emergency calls has been used as an indicator of ambulance service quality in England since 1974. It was revised in 1996 with targets set of eight minutes for life-threatening (category A) and 19 minutes for urgent (category B) calls. Internationally, response time has been used as the benchmark for emergency medical services (EMS) performance. The evidence to support use of response times as a quality measure has been examined.
Methods
A rapid review was used to assess the evidence base for the eight minute response time target. Also, a descriptive observational study of the clinical characteristics of category B calls was performed using two months patient report form data from one English ambulance service.
Results
Five papers were identified that have examined the relationship between response time and mortality for 911/999 emergency call populations. Four papers were from the USA, and in all cases no survival benefit was found for response times > 5 minutes even after adjustment for variables including age, sex and illness severity. This finding was replicated in one UK study. The descriptive study examined call characteristics for 26,882 category B calls. Half of the patients received no intervention other than basic vital signs measurement and 75% had assessment only. Twenty-five percent required some clinical intervention with the majority only requiring oxygen. Less than 5% received significant intervention such as drugs, intravenous cannula, or airway management.
Conclusions
With the exception of cardiac arrest there is consistent evidence that response time has no impact on mortality for EMS calls. Alternative indicators of quality of care should be developed that allow less focus on time targets and more effort on innovation and development of services which could better meet the needs of the majority of patients who do not have a life-threatening problem.
The goal of most EMS is to provide treatment to those in need of urgent medical care, with the purpose of satisfactorily treating the problem, or arranging for timely removal of the patient to the next point of definitive care. Earthquakes are among the most destructive types of natural disasters, striking suddenly with no accurate method of prediction or warning, thereby taking a heavy toll on life, injury and property. The damage created affects all aspects of the community - transportation, telecommunication, and infrastructure and can easily overwhelm local health services, damage clinics, hospitals and render them useless.
Aim
To review the pertinent literature and to analyze the information in order to set practical guidelines for EMS work in earthquakes with a community-based approach.
Results
Survival of casualties extricated from under the rubble depends upon early medical interventions by emergency teams on site. EMS needs to strive for: • early arrival • early qualified treatment • Earthquakes differ from other disasters, where the system is intact.: early transport and definitive care. • They present a vast number of patients • problems concerning availability of medical personnel, • accessibility to patients, means of transportation & communication.
Conclusions
A routine national community-based approach will strengthen the ability to provide early response in both daily and disastrous events, improving both morbidity and mortality rates. Possibly no immediate definitive care.